University College Hospital Research Articles

A better way to implement the QOMS proforma for oncology and reconstruction

<b>Introduction:</b> The BAOMS Quality Outcomes in Oral and Maxillofacial Surgery (QOMS) registries were first rolled out between December 2019 – March 2020 in a pilot-audit, following recommendations for the speciality from the Get it Right First Time (GIRFT) initiative in 2018. At University College Hospital London (UCLH) the QOMS registries are an important part of our daily oncology and reconstruction workflow, and we have worked hard to streamline the significant data collection process. <b>Methods:</b> We adapted the original QOMS paper proformas and produced five bespoke electronic proforma documents, which were fully integrated with our EHRS system - Epic. We customised certain aspects of the documents to better suit the specific case-mix and work patterns of our unit, thereby reducing unnecessary clutter and irrelevant data points. Each proforma is delegated to a named member of the OMFS H&N MDT: Proforma 1 (pre-op) – H&N Clinical Nurse Specialist Proforma 2 (Surgery) – Speciality Registrar Proforma 3 (Discharge) – SHO or equivalent Proforma 4 (6 week F/U) – Speciality Registrar Proforma 5 – (2 year F/U) - Consultant <b>Results:</b> We began collecting data in April 2021, and since this time as a unit we have dealt with 32 Female and 43 Male surgical cases, between a team of 5 surgeons. We have near 100% completion of Proformas 1-4, which demonstrates the efficiency of this approach. <b>Conclusions:</b> We have shown how the potentially time-consuming and tedious process of data collection for QOMS can be streamlined and integrated into a daily workflow through the strategic use of custom proformas and designation of roles.

Work-Related Quality of Life; A Case Study of Resident Doctors at the University College Hospital Ibadan, Nigeria

Work-Related Quality of Life; A Case Study of Resident Doctors at the University College Hospital Ibadan, Nigeria

Pattern of childhood injury in a tertiary centre.

Introduction:Childhood injury and death have been projected to be a disease of public health significance, however, the trend in many developing countries of which Nigeria is one is still unknown. We, therefore, examine the pattern of childhood traumatic injury in our institution.Materials and Methods:The information of patients aged 16 years and below who presented with trauma was extracted from the trauma registry of the emergency units of University College Hospital, Ibadan, from 2015 to 2020. Data were analysed using the SPSS version 20.Results:A total of 3146 children were managed for trauma in the accident and emergency departments of the hospital. Most of them were males (61.2%) and within the under-five age group (36.4%). The majority of the injuries were secondary to fall (41.8%). Male child was more likely to be involved in any mechanism of injury and children between 11 and 16 years were commonly involved in machine hand injury (80%). Following intervention in the accident and emergency department, 44.1% were discharged in the emergency units, 21.5% required admission into the specialist ward, 6.0% died, 5.0% discharged against medical advice and 2.6% were referred.Conclusion:The burden of childhood injury is becoming significant thus demands more attention.

Postmastectomy breast reconstruction awareness and attitudes in Nigerian women with breast cancer: A descriptive, cross sectional survey

Introduction: Sub-Saharan Africa has a high burden of breast cancer and very low rates of breast reconstruction. This study aimed to determine the awareness of and attitude to breast reconstruction among women with breast cancer who had mastectomy. Methods: A cross-sectional study of women with breast cancer who underwent mastectomy was done. Participants were recruited from September 2020 to January 2021 from the surgical oncology and radio-oncology outpatient clinics of the University College Hospital, Ibadan. A multivariate logistic regression was used to determine predictors of awareness and attitudes to breast reconstruction. P ≤ 0.05 was considered statistically significant. Results: Fifty-one women participated in the study. The mean age was 54.76 (+9.94) years. Most, 30 (58.8%) of them had tertiary level of education, were working, 39 (76.5%) and were married, 41 (80%). Funding for the mastectomies was mainly out-of-pocket 34 (66.7%). Most 37 (72.5%) were not aware that the breast could be reconstructed before their surgery and only one (1.96%) of the women had breast reconstruction. The reason most proffered for declining breast reconstruction was not wanting another surgery 13 (33.3%). The age (odds ratio [OR] 0.02, 95% confidence interval [CI] 0.001–0.33), P = 0.006 of the participants and the educational status (OR 12.50, 95% CI 1.86–84.26), P = 0.009 were significant predictors of awareness of breast reconstruction. None of the variables were significant predictors of positive attitudes to breast reconstruction. Conclusion: There is a very low level of awareness of breast reconstruction. Younger age and tertiary education were significant predictors of awareness of breast reconstruction.

Prevalence of Obesity and its primary comorbidities among patients attending the dietetics out-patient clinic in a tertiary health institution in southwestern Nigeria

Objective: The study assessed the prevalence of obesity and its co-morbidities among patients attending the dietetics outpatient clinic of the hospital. Methods: The prevalence of obesity and its co-morbidities were assessed in this retrospective study from the available in the outpatient clinic of the Dietetics Department in University College Hospital Ibadan, Oyo State. Age, gender, occupation, religion, height, weight, diagnosed diseases were extracted from the record of individuals who presented at the clinic over 72 months. Data obtained was analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Result: A total of 3248 patients’ records were assessed. Of these, 1174 (36.15%) patients met the criteria for obesity according to their recorded BMI; 614(52.3%) had obesity class I (BMI 30–34.9), 343(29.2%) had obesity class II (BMI 35–39.9) and 217(18.5%) had obesity class III (BMI ≥40). Obesity was significantly higher amongst females than males (p&lt;0.05). The most prevalent single co-morbidity was diabetes 22.3%, while the most prevalent double co-morbidity was hypertension/diabetes 22.9%. Conclusion: The prevalence of obesity amongst patients was significant. Diabetes and hypertension were the most dominant co-morbidity. Interventions should be developed to combat the increasing prevalence of the diseases and these should involve educating the public and clinical management of the diseases upon identification.

Spectrum of Nasopharyngeal Cancers Seen in the Department of Radiation Oncology University College Hospital, Ibadan

Background: Nasopharyngeal cancer was initially thought to be an uncommon disease in Nigeria, but recent studies have shown a steady increase in the incidence of the disease with an associated increase in morbidity and mortality due to late presentation. Method: This was a retrospective review of patients with nasopharyngeal cancer seen in the department of Radiation Oncology U.C.H. Ibadan from 2000 to 2009. Patient's bio-data, clinical-pathologic presentation and site of referral were retrieved using data extraction form and subsequently analysed using Micrsoft Exel (2013). Results: A total of 205 patients with histologically confirmed nasopharyngeal cancer seen during the study period were analysed. The mean age of the patients was 41.7 years with 144 (70.2%) males and 61(29.8%) females. The commonest presenting complaint was cervical lymphadenopathy in 98.5% of patients followed by nasal blockade, nasal discharge and epistaxis with 82.0%, 78.0% and 51.2% respectively. Undifferentiated carcinoma was the commonest histologic type (68.8%). Majority of patients were civil servants (33.2%). The habit of smoking and alcohol ingestion were unspecified in majority of patients (43.4%). Ingestion of smoked fish has been found in majority of patients 122(59.5%) with the disease in this study. Most of the patients came from southern part of the country which coincide with geographic distribution of Burkitt lymphoma, hence the possibility of Ebsteinbarr virus (EBV) as one of the likely causative agents. Conclusion: Nasopharyngeal cancer is common. Cervical lymphadenopathy, nasal blockade with undifferentiated histology and late presentation were the norm. Referrals were from all the regions of the country.

Early Metastasis in Different Types of Breast Carcinoma - A Personal Experience

Background: Carcinoma breast is one of the leading causes of death in woman today and is the most common cancer among women. More than 2.3 million of women are diagnosed breast cancer each year world-wide. Carcinoma breast may present from an extent of non-palpable lump to a fixed mass with distal metastasis. As presentation is highly variable, management strategy varies even in same stage of disease.&#x0D; Objective: To identify early metastasis of different types of breast carcinoma and its management.&#x0D; Materials and methods: This is a prospective type of observational study in 100 cases done in the different surgical units of Dhaka Medical College Hospital (DMCH), Bangabandhu Sheikh Mujib Medical University (BSMMU) and Bashundhara Ad-din Medical College Hospital (BAMCH).Patients were selected clinically and by some standard investigation (FNAC and core biopsy) from January 2006 to December 2018.&#x0D; Result: Patients at different age groups had suffered from different types of breast carcinoma. Early diagnosis by triple assessments and proper surgical and post-surgical managements reduced both loco- regional and distant metastasis and also reduced both morbidity as well as mortality. Results of treatment and histopathological reports were recorded. It was found that FNAC is cheap and minimally invasive diagnostic procedure with high sensitivity (100%) and specificity (95%).Core needle biopsy is more accurate tissue diagnostic in breast cancer. Down staging has profound symptomatic and cosmetic benefit. In renders inoperable tumors become operable and reduce morbidities.&#x0D; Conclusion: Early diagnosis and treatment is the mainstay to achieve satisfactory outcome. Screening program especially Self-Breast Examination (SBE) is very much helpful in early diagnosis of disease in our social setting. Screening mammography has had the most substantial impact on the early diagnosis of, and subsequent decrease in mortality from breast carcinoma. Women of 20-40 years of age should have a breast examination every 2-3 yearly. Women of more than 40 years of age should have a breast examination every yearly.&#x0D; AKMMC J 2022; 13(1) : 14-21

Conventional Pap Smears for Identification of Infectious Organisms (Trichomonas vaginalis, Gardnerella vaginalis and Candida albicans) among Patients Attending University College Hospital, Ibadan

Conventional Pap Smears for Identification of Infectious Organisms (Trichomonas vaginalis, Gardnerella vaginalis and Candida albicans) among Patients Attending University College Hospital, Ibadan

Emerging Characteristic Profile of Patients on Multi-Drug Resistant Tuberculosis Treatment in Oyo State Drug-Resistant Tuberculosis Treatment Centres

Background: The global pandemic of tuberculosis has left everlasting scars on people’s lives. Drug-resistant tuberculosis is becoming an increasingly serious hazard to public health. With over 240,000 fatalities due to drug-resistant tuberculosis (DR-TB) worldwide, and Nigeria is one of the 14 nations with a significant multi-drug resistant TB burden, increased focus on dis-ease control is needed. Methods: The study was a retrospective cohort study. A total of 149 patients diagnosed using the gene Xpert machine and referred to the DR-TB treatment centers in University College Hospital and Government Chest Hospital were recruited. Data were collected from the patients’ case files and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Results: One hundred and forty-nine MDR-TB patients were enrolled in the study, of which 12.75% were new cases while 130 (87.2%) were on retreatment. The prevalence of MDR TB mortality was 4%. However, 30.9% had normal PCV at baseline while 68.5% of those enrolled had abnormal PCV. A total of 22(14.8 %) were reactive to the HIV test, while 125(83.9%) were not. At baseline, Body Mass Index (BMI) showed that 16.1% had a healthy weight, 18.1% were underweight, 2.7% were over-weight, and 59.7% were obese. At four months of treatment, BMI shows that 59.1% had healthy or normal weight, 12.8% were underweight, 6.0% were overweight, and 0.6% were obese. At four months, a significant association was observed between the baseline PCV, HIV status, hypertensive state, and the MDR-TB patient’s treatment outcome (p &lt; 0.05). Conclusion: The category of MDR TB patients had a significant outcome in the patient’s survival. New patients on treatment had better survival outcomes than retreatment cases. The baseline PCV and HIV status had a significant impact on the treatment outcome of the MDR-TB patients at four months of treatment TB. Also, good care needs to be intensified in MDR-TB patients that have HIV so as to improve the treatment outcome of such patients.

Diabetes Self-Efficacy and Associated Factors among People Living with Diabetes in Ibadan, Southwestern Nigeria

With the increasing prevalence of diabetes mellitus (DM) globally, including in Nigeria, self-care practices are universally recognized as imperative to keeping the illness under control and preventing complications. It is important to determine how competent patients feel about managing their diabetes; as well as their psychosocial adjustment. Self-efficacy measures these important aspects of diabetes care and act as a guide to health professionals on how best to tailor diabetes education and support. There is a dearth of studies on self-efficacy and associated influences, among people living with diabetes in Nigeria. Hence, this study was carried out to fill the lacunae. This descriptive study was carried out at the Out-patient Clinic of the University College Hospital (UCH), Ibadan, among 235 people receiving treatment for diabetes. A total sampling of all available patients who provided consent at the time of data collection was done. The instrument for data collection was a questionnaire consisting of a section on sociodemographic and clinical characteristics including fasting blood glucose; followed by a section on diabetes self-efficacy. Diabetes self-efficacy was measured using the validated and adapted Michigan Diabetes Empowerment scale (DES). Ethical approval was obtained from the University of Ibadan/University College Hospital Institutional Review Board (UI/UCH IRB). Data were entered into the Statistical Package for Social Sciences, version 20. Data were analysed using frequencies, percentages, mean, independent t-test and Pearson’s correlation at α 0.05. Participants were predominantly women (60.9%) and had a mean age of 59.3 ± 14.0 years. More than half of the participants (55%) had a high self-efficacy level. Educational level and having a family member who is a nurse or a doctor were significantly associated with high self-efficacy. Fasting blood glucose level was negatively correlated with self-efficacy and the domain of managing the psychological aspect of diabetes. A good percentage of people living with diabetes had high self-efficacy, which was influenced by educational level and having a health professional as a relative. Those with high self-efficacy had better glucose control. It is recommended that individually-tailored diabetes education be provided for people with poorly controlled glucose level.

Relationship between Vitamin D Status, Dyslipaedemia and Antioxidant Status in Children with Idiopathic Nephrotic Syndrome in South West, Nigeria

Dysregulated lipid metabolism and oxidative stress are strong factors that are implicated in the development of proteinuria and glomerular injury in Nephrotic Syndrome (NS). Vitamin D seems to be a promising tool in influencing lipid metabolism and antioxidant status in NS.&#x0D; Aim: This study aims at investigating the relationship between Vitamin D, dyslipaedemia and oxidative stress in NS.&#x0D; Study Design: This is a case-control study.&#x0D; Place and Duration of Study: Children’s Outpatient Clinic (CHOP) of University College Hospital (UCH) Ibadan, Nigeria between year 2019-2021.&#x0D; Methods: This study involves fifty children aged 5 to 12 years, freshly diagnosed with Idiopathic NS and fifty apparently healthy children as control. Blood samples were taken from them and analytes quantified by standard laboratory methods. Students’ t test and Pearson correlation were used to compare variables between the two groups respectively.&#x0D; Results: Results showed significant decrease (P &lt;.001) in Vit. D levels, GPX, SOD and CAT in NS. A significant decrease (P&lt;.001) occurred in HDL, a significant increase (P &lt;.001) in TG, TC and LDL levels in children with NS when compared with the control. There was a strong significant positive relationship between Catalase and Vit. D, SOD and Vit. D (r= 0.896, 0.869 respectively, P&lt;.001) in NS. While a weak non significant positive relationship occurred between HDL and Vit. D, GPX and Vit D (r=0.0585, 0.0236 respectively, P &gt;.001). A weak negative relationship occurred between TG and Vit. D, TC and Vit. D, LDL and Vit. D (r=-0.0432,-0.219, -0.231 respectively, P&gt;.001), in NS. Thus, vitamin D insufficiency influences serum lipid profiles and antioxidants in paediatric Idiopathic NS.

The contribution of family physicians to primary health care: Experiences from southwest Nigeria.

Although an emerging speciality in Africa, family medicine contributes significantly to African health systems. Leadership from family physicians can enable the delivery of high-quality primary health care that is accessible, comprehensive, coordinated, continuous and person-centred. This short report chronicles how family physicians from a university teaching hospital in Ibadan, Nigeria, adopted a health post located in a home for persons with mild physical and mental disabilities and changed it into a hub of comprehensive, holistic and person-centred care for residents and staff of the home, as well as individuals and families in the neighbouring communities and its environs. The Department of Family Medicine of the University College Hospital, Ibadan, with the aid of a benefactor, reorganised a modest health facility to include the services of family medicine senior registrars (undergoing training-related rotations) with supervision by consultant family physicians. Family physicians led the primary health care team that provided both facility-based care and community outreach services. This report demonstrates how family physicians can improve the quality of primary health care and outcomes such as health equity in the community served.

Access to Anti-Diabetic Medicines among Patients Attending Tertiary Health Facilities in Oyo State, Nigeria

Objective: The management of Diabetes Mellitus (DM) is long-term and can be expensive. This study aimed to describe access to anti-diabetic medicines among patients in tertiary health care facilities in Oyo State, Nigeria. Materials and Methods: This was a hospital-based cross-sectional study. The study sites were the University College Hospital (UCH), Ibadan, and Ladoke Akintola University Teaching Hospital, Ogbomosho. It was conducted among 366 diabetic patients who had been attending the endocrinology clinic of these two tertiary health institutions for at least one year. Data analysis was done with the Statistical Program for Social Sciences. Results: Female participants were 186 (50.8%) and 298 (85.6%) depended on close relatives to purchase their drugs. Those who had difficulties affording their anti-diabetic medications were 142 (38.8%) and 80 (56.3%) preferred buying a cheaper brand of anti-diabetic medication. Also, 136 (37.2%) respondents had missed their required drugs at some point due to insufficient funds. Males who were able to afford their anti-diabetic medication were 96 (53.3%) compared to 128 (68.8%) females (P-value= 0.002). Those with no formal education had the highest proportion of respondents who could not easily afford anti-diabetic drugs (60.9%), those with tertiary education had the highest proportion of respondents who could afford their medication (77.5%), (P-value=&lt; 0.001). Among those in the 61-70 years age group, 78 (66.1%) achieved glycaemic control compared to 34 (42.5%) of those above 70 years (P-value=&lt; 0.001). Conclusion: To improve affordability, subsidizing the cost of anti-diabetic medications and encouraging patients to enrol in the Health Insurance Scheme will be beneficial.

Professor Adelola Adeloye (1935–2021): An icon in the annals of medicine

We celebrate the life of a great physician-surgeon, Adelola Adeloye, an Emeritus Professor of Neurosurgery at Nigeria’s premier medical school, The College of Medicine, University of Ibadan, and retired Consultant Neurosurgeon, University College Hospital, Ibadan.

Prevalence and outcome of care among patients with spinal cord injury in a Nigerian Tertiary Health Institution

ObjectiveThis study assessed the prevalence, causes, pattern of management and outcome of care among patients SCI in University College Hospital, Ibadan, Nigeria. MethodsThe study adopted a retrospective research design and case files of all patients with spinal cord injury that received treatment at the hospital from 2015 to 2018 were used for the study. A self-developed checklist was used for data collection. Collected data were analysed using the statistical package for the social sciences (SPSS) version 25. The data were presented with descriptive and inferential statistics at a significance level of p = 0.05. ResultsFindings showed that 132 admitted patients out of a total of 850 admissions over four years had SCI with a prevalence rate of 15.5% with highest percentage in 2018 and 65.2% of the SCI resulted from trauma and 34.8% were non-traumatic. Majority of the patients (99.2%) were given analgesics, 97.7% were placed on bed resting, 90.2% received psychotherapy, 89.4% were placed on adequate nutrition, 71.2% were placed on anticoagulants 68.2% placed on catheterization and 57.6% benefited from surgery. Findings also showed that outcomes of care for spinal cord injury ranges from Paraplegia (29.5%), salvaging of bladder or bowel continence (25.0%) and Quadriplegia (15.2%). ConclusionThe study concluded that there is high prevalence of SCI and trauma, road traffic accident and occupational hazard were the major causes of spinal cord injury.

Endoscopic and histopathological findings in adult dyspeptic patients, and their association with Helicobacter pylori infection in Dhaka, Bangladesh

Conventional upper-intestinal endoscopy is usually performed to diagnose Helicobacter pylori (H. pylori) associated diseases, using gastric mucosa from the biopsy. The objective of our study was to identify the prevalence of H. pylori and its relation with endoscopic findings and histopathological features in dyspeptic adult patients. Gastroduodenal biopsy specimens were collected from 143 adult dyspeptic outpatients who attended the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH), for endoscopy. H. pylori was identified by rapid urease test (RUT), ureC gene PCR, and histological staining (Giemsa). The study population was divided into H. pylori-positive cases (47; 32.9%) and H. pylori-negative cases (96; 67.1%), based on the case definitions used in the study. The highest rate of H. pylori infection was found in the 41-50 years age group (25.5%). Endoscopically, 101 (97.1%) dyspeptic patients had gastritis, with the majority of H. pylori infections found among histopathologically diagnosed duodenal ulcer patients. Endoscopic findings were significantly correlated with histological findings (p < 0.001). Significant correlations between endoscopic and histopathological findings were observed. Early detection and prompt treatment of H. pylori infection are essential for the prevention of serious complications.

Single Centre Analysis of JAK2 V617F and Exon 12 Negative Idiopathic Erythrocytosis

▪IntroductionThe molecular categorisation of myeloproliferative neoplasms (MPNs) has changed the landscape of diagnosis and treatment. Polycythaemia vera (PV) is characterised by red blood cell proliferation and JAK2 V617F or Exon 12 mutations in up to 98% of patients 1. However, some patients without such mutations have an arduous diagnostic course with varying management and prognostic outcomes 2. We present our experience in managing this challenging cohort and aim to illuminate a potential diagnostic pathway for patients.MethodWe searched electronic records of patients attending haematology clinics over the last 20 years at University College Hospital with a prior diagnosis of PV / erythrocytosis (presenting with raised Haemoglobin (Hb) &/ Haematocrit (Hct)) with no evidence of JAK2 exon 12 or 14 mutations on bone marrow or peripheral blood molecular analysis (multiplex PCR sensitivity 0.1%). We reviewed their diagnostic workup, which included full blood count & where available, bone marrow myeloid (Illumina TruSight Myeloid) & erythroid next generation sequencing (NGS) panels.Results37 patients with JAK2 V617F & Exon 12 mutation negative erythrocytosis were identified. Patients were categorised in to 3 groups 2; idiopathic erythrocytosis (IE), secondary polycythaemia (SP) & high affinity haemoglobinopathies (HAH); patient characteristics are summarised in Table 1. The median age of IE & HAH was younger, their presenting Hb/Hct levels was higher compared to SP, with a male predominance. Constitutional symptoms were only reported in the IE cohort. Erythropoietin (EPO) was elevated in HAH & IE patients but within normal range in SP. Thrombotic events occurred in all cohorts, most frequently in IE. Splenomegaly was reported in 4/21 IE, 1/13 SP, but was not a feature in HAH patients. When performed, IE red cell mass (RCM) studies were raised but within normal range in SP patients. Table 2 details IE cohort erythroid mutations. Myeloid NGS only identified MPL and BCOR mutations of pathogenic significance and multiple single nucleotide polymorphisms of no known significance. No abnormalities were demonstrated in 15% of SP patients that underwent bone marrow myeloid mutational analysis. Venesections (VS) were instigated in 95% of the IE cohort, antiplatelets (AP) in 52%, anticoagulation (AC) in 14% and cytoreductive therapy (CT) in 19% due to intolerance/failure of VS. VS programme was instigated in 46% of SP patients, AP in 7% and AC in 47%.DiscussionThe median age of our IE cohort was 48 yrs with a 19% incidence of thrombosis. Where performed, bone marrow histology demonstrated hypercellularity but was not consistent with MPN diagnostic criteria. Myeloid NGS panel mutations such as BCOR may represent clonal haematopoieis of indeterminate potential. Heterozygous VHL C598T & C376A mutations, in keeping with Chuvash polycythaemia, were demonstrated. Mutations in EGLN1 &BPGM,were detected in our patients, however there was an absence of correlating haematological parameters or family history to support a diagnosis of congenital erythrocytosis (2). Variants of unknown significance were also detected in SH2B3, BMP6 &EGLN3 gene duplication. SP patients were older (median age 68 years) and where performed had normal RCM and no myeloid mutations identified.The initial approach adopted at our centre for diagnosing and managing JAK2 V617F & Exon 12 negative erythocytosis begins with clinical evaluation for secondary causes. This is followed by assessment of EPO level, RCM study, extended molecular mutational analysis involving screening for high affinity haemoglobins, congenital erythrocytosis and bone marrow histology. Where patients are symptomatic or considered at high risk for thrombosis, we venesect to a personalised target and patients are offered AP and/or AC. CT is instigated where VS is not tolerated or ineffective, however this approach is not corroborated in the literature. Our experience highlights the clinical heterogeneity of JAK2 negative erythrocytosis and the need to develop a robust and systematic diagnostic and treatment algorithm with further clarification of the role of molecular profiling.1. William W, Kralovics R. Genetic basis and molecular pathophysiology of classical myeloproliferative neoplasms. Blood. 2017 Feb; 129(6):667-6792. McMullin MF. Idiopathic erythrocytosis: a disappearing entity. Hematology Am Soc Educ Program. 2009; 2009(1):629-635 [Display omitted] DisclosuresSekhar: Novartis: Consultancy, Research Funding.

The Interaction of Sickle Cell Trait and Anticardiolipin Antibodies in Venousthromboembolism

IntroductionAmong the risk factors for venous thromboembolism (VTE) are inheritance of the sickle cell gene and antiphospholipid syndrome. Antiphospholipid antibodies are elevated in sickle cell disease but there is little information on its levels in sickle cell trait. The prevalence of anticardiolipin antibodies and association with VTE is equally not known in the Nigerian population.MethodsA case control study involving 50 consecutive patients with Doppler confirmed venous thromboembolism at the University College Hospital Ibadan and 50 apparently healthy individuals. Haemoglobin electrophoresis was carried out using cellulose acetate membrane. IgG and IgM anticardiolipin antibodies were assayed by ELISA.ResultsThe mean age of the patients was 58.7±18.5years, range of 21-89 years, there were 21 males (42%). Majority of the patients (42 (84%)) had deep venous thrombosis while five (10%) patients presented with pulmonary embolism, one had both deep venous thrombosis and pulmonary embolism. A patient had portal vein thrombosis and another, an intracardiac clot. Sedentary lifestyles, hypertension and concomitant malignancy were the most prevalent risk factors (34% each) (figure I). Both sedentary lifestyle and cancer were significantly associated with VTE (p<0.001). Sickle cell trait (Hb AS) occurred in the same number of patients and controls (eleven each). Higher levels of both IgG and IgM anticardiolipin antibodies were found among the VTE patients with sickle cell trait than controls. (Table 1) The mean levels of IgG antibody in Hb AS patients was 31.7 ± 12.8 GPL compared to 25 ± 13.8 GPL in the controls (p= 0.254) and mean IgM anticardiolipin antibodies in Hb AS patients was 18.7 ± 6.2 GPL while that of the controls was 16.8 ± 11.6 GPL (p= 0.633). The global mean levels of IgG and IgM anticardiolipin antibodies in the patients with VTE were 29.7 ± 9.1 GPL and 24.8 ±16.7 GPL respectively versus 28.5 ±13.7 GPL and 25.2 ±16.2 GPL in the controls. A multivariable logistic regression showed age, sedentary lifestyle and anemia as independent risk factors while a positive IgM anticardiolipin antibody appeared protective for VTE. (Table 2)ConclusionThe prevalence of sickle cell trait and anticardiolipin levels did not differ between VTE patients and healthy controls. Age, hypertension, sedentary lifestyle and malignancies were identified risk factors in our cohort of patients. Larger prospective studies may be helpful in determining the influence of sickle cell trait and antiphospholipid antibodies in venous thromboembolism. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Use of Intermittent Preventive Therapy and Incidence of Acute Malaria in Pregnancy among Postpartum Women at University College Hospital, Ibadan, Nigeria

Background: Malaria in pregnancy remains a significant cause of feto-maternal morbidity and mortality especially in regions of high prevalence like Nigeria. Intermittent preventive therapy (IPT) for malaria is an important measure to abate this menace. Aim: The aim is to determine the uptake and effectiveness of IPT in relation to the occurrence of malaria, despite the use of IPT in pregnancy. Patients, Materials and Methods: This was a cross-sectional study conducted in UCH, Ibadan from October 1, to December 31, 2020. A total of 150 postpartum women were selected using the total sampling technique of all consenting participants. Structured questionnaires were used for data collection. Results: About 87.7% of the respondents took IPT in the index pregnancy. Of these, 15.4%, 50.8%, and 33.8% of participants took one, two, and three doses, respectively. The factors that determined intermittent preventive treatment for malaria in pregnancy (IPTp) uptake include occupation (P = 0.001), booking status (P = 0.002), antenatal care attendance (P = 0.001), and level of IPTp awareness (P = 0.002). About 48.0% of respondents indicated that they were treated for malaria in the index pregnancy. Meanwhile, only about 15.3% of those who took IPT were treated for malaria in pregnancy. It was found that the use of IPT (P = 0.03) and an increasing number of IPT doses used (P = 0.03) were associated with a reduction in the prevalence of malaria in pregnancy. Conclusion: The uptake of the current recommendation for IPT-SP that stipulates the use of monthly doses of IPT till delivery with a target of a minimum of three doses was quite poor. There is therefore an urgent need for widespread awareness and implementation of the World Health Organization and national guidelines on prevention of malaria. The prevalence of malaria declined with the number of doses of IPT-SP used by the respondents. This emphasizes the need for adequate dosing of IPT.

EP.FRI.477 Neutrophil-To-Lymphocyte Ratio (NLR) as a Predictor of Acute Appendicitis

Abstract The most common reason for an acute surgical assessment of the abdomen is acute appendicitis with a rate as high as 30 %There is a lifetime risk of 8.6% and 6.7% in men and women respectively. The common age for presentation is between that of 5 and 4.4 while 28 is the median age. The objective of this study was to determine the diagnostic accuracy of (NLR) neutrophil-to-lymphocyte ratio to prognosticate severe/ complicated appendicitis by taking histopathology of the appendix as a gold standard. Methodology This cross-sectional validation study was conducted at the department of surgery and western vascular institute, University College Hospital Galway, Ireland retrospectively for a period of 6 months in 2016 And approximately 186 cases with appendicitis were enrolled in the study. Results The mean age of patients in this study was 29.15±9.54 years, the ratio of male to female was 1:1.7. The sensitivity, Specificity was 97.1% and 25.2% respectively and the diagnostic accuracy of NLR was 38.7% taking histopathology as the gold standard. We observed that the sensitivity, specificity, and diagnostic accuracy of NLR changes with the duration of symptoms in days, the sensitivity, specificity, and diagnostic accuracy of NLR was 100%, 17.0%, and 28.7% respectively for &amp;lt;3days and 92.3%, 93.75% and93.1% respectively for &amp;gt;3 days. Conclusion According to our study results the (NLR) neutrophil-to-lymphocyte ratio is a highly sensitive tool to predict severe/ complicated appendicitis by taking histopathology as the gold standard, but with the low value of diagnostic accuracy in terms of specificity.